Anaphylaxis

Question:

I have a client who has been diagnosed with Anaphylaxis. Her physician did not give her much information on what to do or to avoid. Can anyone on your team help me with this?

Answer:

First, my short lecture: A physician should always make sure that the patient fully understands, and the patient should make sure that she fully understands. Both were remiss in not fully communicating.

Since the patient is "under your care" for one to three hours per week, now the onus is on you to help her get a full explanation from her doctor. As you'll read, anaphylaxis can kill.

Anaphylaxis is a sudden, severe and potentially fatal (150 to 200 U.S. deaths each year) systemic allergic reaction. It typically occurs within minutes to two hours after contact with the allergy-causing substance.

The most common causes of anaphylaxis are foods, medications, insect stings and latex, but there are also cases of Food-Dependent Exercise-Induced Anaphylaxis and Idiopathic Anaphylaxis.

The most common foods that can cause anaphylaxis are peanuts, cashews, walnuts, eggs, milk, fish, shellfish, some fruits and certain spices.

As much as 10 percent of the population may be allergic to certain medicines. NSAIDs, aspirin, penicillin and anesthetics are common culprits. Beware of beta blockers in particular since they block the main defenses against anaphylaxis.

Obviously, this is a concern only if you're doing outdoor training, but bees, yellow jackets, hornets, wasps and ants stings account for about 50 U.S. deaths each year. The symptoms of anaphylactic reactions to insect stings usually occur within minutes of the sting. Be on the lookout for faintness, difficulty breathing or a rash or swelling of a part of the body that has not been stung.

Latex anaphylaxis is more common in people with frequent exposure to latex. It affects about one percent of the general U.S. population but as much as 17 percent of health care employees. Some people with latex allergy will also develop reactions when eating certain foods such as bananas, avocados, kiwi fruit, figs, potatoes and tomatoes.

Food-dependent exercise-induced anaphylaxis is very rare and occurs only when the victim eats a specific food (typically include wheat, shellfish, fruit, milk, celery or fish) and exercises within three to four hours after eating. This type of anaphylaxis typically involves asthma and is twice as common in females.

Idiopathic anaphylaxis is a severe reaction where no cause can be determined. It can affect individuals of all ages, although females are affected much more frequently than males.

Prophylactic daily treatment with a combination of medications can control the symptoms.

Some top experts who have studied hundreds of patients with idiopathic anaphylaxis believe it is a disorder of mast cells, causing them to release histamine and chemicals with similar actions too easily.

Remember, it's not within your scope of practice as a personal trainer to diagnose, only to recognize the signs and symptoms and be prepared to relay that information to EMTs and physicians.

Faintness with a rash or swelling coming on quickly is probably anaphylaxis, and if there is also difficulty in breathing, the danger is greater. Faintness with difficulty in breathing alone will sometimes be due to a panic attack but can also be due to anaphylaxis.

It's important you understand these symptoms of an anaphylactic reaction:

• A tingling sensation or itching
• Metallic taste in the mouth
• Hives
• A sensation of warmth
• Asthma symptoms
• Swelling of the mouth and throat area
• Tingling feeling in the lips or mouth if the cause was a food (such as nuts)
• Swelling in the throat, causing difficulty in swallowing or breathing
• Difficulty breathing
• Vomiting
• Diarrhea
• Cramping
• A drop in blood pressure
• Loss of consciousness

You should also be aware of the bi-phasic reaction phenomenon. In some cases, symptoms go away but return two to three hours later.

Ask your client's doctor (ask directly and not through the client) exactly what she should do if she has a reaction. You need to be prepared in case she's unconscious, too faint or too anxious to give you instructions herself. In this case, you should call Emergency Medical Services (or 911) and request epinephrine.